This story is the product of a collaboration between New York Focus and THE CITY.
A letter sent Tuesday by a federal monitor overseeing New York City jails sounded the alarm on a “high level of disorder and chaos” and a failure to “provide basic services to people in custody.”
Fueling the escalating crisis is a staffing shortage that’s also made getting medical care at Rikers Island and other city lockups an ordeal, an investigation by New York Focus found.
City jails records show thousands of missed medical appointments each month, at a time when prompt care is especially urgent. In March 2021, one in five scheduled doctors’ visits didn’t happen — 12,914 in all.
The reason, the jails’ leadership and the unions representing staff agree, is that there simply aren’t enough correction officers on hand to escort people to appointments.
The letter from monitor Steve Martin to U.S. District Court Judge Laura Swain highlighted the severe security risks — including suicides in cells and escalating use of force by officers — resulting from a staffing crisis that has over a third of the department’s uniformed officers sidelined.
As detailed by the monitor, the Department of Correction reported that at the end of July, about 1,650 out of 8,500 officers were out on sick leave, while another 1,400 were on restricted duty that kept them away from incarcerated people. Those numbers don’t include an additional 2,300 times throughout the month that officers missed work without calling in.
One Rikers Island health provider, who asked not to be named, said that a backlog of patients waiting to see medical staff has grown dramatically since staffing shortages spiked late last year.
“Patients often, in my view, wrongly assume that it’s us who don’t want to see them, as opposed to the Department of Corrections that’s preventing us from seeing them,” the health provider said — a situation “waiting for disaster” if another COVID-19 wave were to hit the jail.
Currently, people experiencing flu-like symptoms typically wait three days to one week to be seen by a doctor, according to the health provider — too long to isolate COVID cases.
“Time is important for COVID-19 in a congregate setting,” the provider said. “In the last year, it’s gone up and up and up.”
‘I Still Have the Damage’
In an interview with New York Focus, Vincent Schiraldi, the recently appointed DOC commissioner, pointed to the staffing shortage as the principal cause of problems with access to medical care.
“Things are getting canceled all the time here — religious services visitation, recreation, commissary,” Schiraldi said. “When you don’t have enough staff, it creates lots and lots of problems — and producing people to sick call is one of them.”
But the issue of missed appointments dates to the days before COVID-19 or the current staffing crisis. In fall 2019, when 12,750 appointments were missed in October alone, the experience of one person held at Anna M. Kross Center on Rikers demonstrated the consequences for people denied care.
That person, who asked that his name not be published, developed a rash while incarcerated that became so painful and itchy that he couldn’t sleep and had difficulty eating.
For weeks, he requested to see a doctor but could not get an appointment at all. Once he finally got medical visits scheduled, correction officers told him that because it wasn’t an emergency, there was no one to escort him to see medical staff.
It turned out that he had contracted scabies. It took over two months for him to receive proper medical attention, he said. He has scars all over his body to this day.
“My body was getting eaten up by this sickness,” he said. “I was complaining for weeks and weeks. I still have the damage.”
The corrections officers’ union has called for the city to hire over 2,000 more officers to improve jail conditions — while the jail’s agency has countered that the core problem is the extraordinarily high portion of its workforce that refuses to come to work.
Hundreds of correction officers and health practitioners protested jail conditions last week at the foot of the bridge to Rikers Island, chanting “stop the triple shifts” and “safer jails now.”
One correction officer at the protest told New York Focus that were it not for the staffing crisis, more officers would be available to escort people to medical appointments.
“You cannot step away from your post,” the officer said. “You’ll be thinking, ‘I’ve been sitting here for 16, 17 hours, how can I physically and mentally care for all of these people?’”
The officer said that showing up for work, while so many other colleagues stay home, means that she often gets pulled into working three days in a row and forced to skip meals when there isn’t another officer to relieve her.
“Where does that leave us?” she added. “Management has to care about their staff.”
New York City correction officers have unlimited paid sick leave as part of their benefits package, which the monitor’s letter said is “being increasingly utilized and possibly abused.” Officers say the benefit is necessary for a job that involves frequent and sometimes violent confrontations.
Absences have risen steeply over the last year, according to monthly data provided to New York Focus by the Department of Correction.
The average daily number of sick leaves more than doubled between July 2020 and July 2021. The number of officers not coming to work without calling in more than tripled over roughly the same time period, and the number of officers on medical monitoring status rose by 73%.
Penalties for officers absent without leave vary and can include salary deductions for missed work and a reduction in vacation days. Personnel may receive further disciplinary action when warranted, said DOC spokesperson Latima Johnson, but not showing up for work itself is not grounds for immediate termination.
The monitor’s letter noted that unsafe conditions and underlying staffing problems are the result not only of recent absenteeism, but also of “decades of mismanagement” of staff deployment — which the monitor called “the most fundamental issue impacting the conditions in the jails.”
A Series of Attacks
Patrick Ferraiuolo, president of the Correction Captains’ Association, acknowledged the spike in sick leave but doesn’t blame officers for calling out, given recent attacks on officers.
“The commissioner asked me if I would ask correction officers to come back to work and I said, ‘Are you out of your f–king mind?’” Ferraiuolo said.
In a series of attacks in March, including an incident where a person who was incarcerated hauled a fire extinguisher at an officer, 11 correctional staff were injured, leaving some with concussions and broken ribs.
In July, a correction captain was smeared with feces by an aggravated detainee. And earlier this month, a guard was beaten and pepper sprayed. With the rise in attacks, Ferraiuolo said detainees should be “locked in” before guards are asked to work triple shifts.
Correction officers chanted “bring back the box” at last week’s protest, in response to the Board of Corrections’ recent vote to reform solitary confinement in New York City jails. Use of so-called punitive segregation had already been severely restricted by the board, limiting correction officers’ ability to lock up and isolate.
“There’s less ability to put people in a punitive state, which this department relied very heavily on,” Schiraldi told New York Focus. “And so the way that staff experiences this is: the people who broke the law are getting punished less and we’re getting punished more. Why should I go to work today?”
‘Our Hands Are Tied’
Complaints about access to health care dominate grievances filed by incarcerated people, reports required by the City Council show: A third of all grievances filed since October 2019 centered on medical access concerns, far more than any other category.
While missed medical appointments aren’t new at city jails, getting an appointment in the first place has become tougher since COVID ravaged Rikers Island last spring and the staffing crisis struck the jail complex a few months later.
Medical staff say that “call down lists” — logs of patients waiting to be seen for health care services — have quadrupled in some facilities in the last couple of years, as health professionals see fewer patients, wait for no-shows when escorts aren’t available and are forced to push back appointments again and again.
“As call lists gets longer, inevitably we’ll be missing people who are now at moderate risk for self-injury and suicide,” said George Anderson, a mental health administrator for Correctional Health Services, who has worked on Rikers Island for five years.
Anderson said that with such long wait times for medical care — sometimes weeks, where it was once days — there is now a greater incentive for inmates to self-harm in order to be seen. He noted that in mid-August someone wrote “help” in blood at one facility.
The monitor’s letter found the number of self-harm incidents and the response from staff “troubling,” citing at least four in-custody suicides since December 2020.
Jeanette Merrill, a spokesperson for Correctional Health Services, a division of the city Health + Hospitals organization, said DOC staffing shortages were to blame for increased wait times.
“The department’s staffing shortages are affecting health operations, including the availability of escorts to bring patients to the clinic and of DOC personnel to staff the clinics,” she said. “In response to this shortage, as we’ve prioritized critical services to highest risk patients in response to availability of DOC resources, the number of patients awaiting less critical care has grown.”
Anderson phrased it another way. “Our hands are tied,” he said. “CHS has done its best to adapt to DOC staff shortages. We’ve opened new units, we’ve tried everything. It doesn’t feel like there’s an end in sight.”
Before the sick-outs, DOC had the highest correction officer staffing levels of any jail system in the country, currently employing about four officers for every three incarcerated people, New York Focus and THE CITY reported last month.
Yet even before COVID, missed medical appointments had caught the attention of the court-appointed monitor overseeing the jails. Martin cited frequent lockdowns, searches and alarms that trigger emergency response teams — all of which prevent people from leaving their cells — as factors.
The monitor has recommended medical treatment within the housing units or from a location other than the clinic. “And, if individuals must be moved, staff other than the emergency response team may be better suited to the task of escorting,” the monitor’s May report reads.
Recommendations in a 2018 report by the Board of Corrections, the jail oversight agency, mainly urged DOC and CHS to better track the problem. Both began publishing more detailed data the following year, as a result of new city legislation.
Schiraldi told New York Focus that he has set up weekly meetings with Correctional Health Services to make access to medical appointments a priority.
‘Don’t Bother Me’
Health and community advocate Greg Williams, 55, who earlier this year testified before the City Council on his observation of groups of idle correction officers loitering for long periods of time, doesn’t buy the inadequate staffing justification.
“I don’t get it,” Williams said. “How can you be understaffed when you have officers sitting around doing absolutely nothing?”
In August 2020, while incarcerated at a Rikers facility, Williams accidentally jammed his two fingers in his bed frame. He didn’t think much of it, but after a week passed his fingers were so swollen that he was afraid they would remain gnarled indefinitely.
He asked to see a doctor so that he could have his hand X-rayed. When the appointment came a week later, he was ready in his cell for a correction officer to take him to the medical unit — less than a five-minute walk away in the building next door. Nobody ever showed up to escort him, he said. There was a group of guards standing by, but Williams says they claimed that not one could take him to his appointment.
“You just get the runaround,” he said. “It seems like the more staff they have available, the less gets done.”
He waited three weeks for his next appointment, only to face the same scenario: waiting in his cell for his escort and never being taken to the doctor. By this point, his hand was in so much pain that it couldn’t bear weight, and he couldn’t bathe properly.
On his third attempt, a guard came to accompany Williams and he made it to the doctor for an X-ray. Six weeks had passed.
“When it comes to the people who are supposed to be in their care, it’s the opposite,” he said. “There’s no such thing as immediate attention.”
Today, he said, his fingers are still “permanently twisted.” He wonders what his fate would have been had he suffered a back injury.
What Williams calls the “if you’re not dying don’t bother me” mentality has led to officers documenting that a person has refused treatment when they haven’t, and at times has even led to officers forging signatures on refusal documents, said Samantha Catalanotto, a social worker with the Bronx Defenders.
When there are urgent medical needs, social workers can make recommendations to Correctional Health Services on behalf of a client.Then correctional health staff can proactively request that DOC send that person for medical treatment—but it can still take weeks before the request makes it across the chains of command.
“It takes a lot of advocacy on our part,” Catalanotto said. “It’s an experience that we see time and time again: people just not getting the medical attention that they are rightfully in need of.”
Dr. Victoria A. Phillips, a member of DOC’s advisory board, said that the problem stemmed from pervasive mismanagement and a lack of internal accountability mechanisms.
“It costs almost half a million dollars a year to incarcerate one individual according to DOC’s budget,” said Phillips, an organizer with the Urban Justice Center’s Mental Health Project who has worked for over 15 years in various health divisions on Rikers Island.
“Yet in that budget, you can’t even take someone to a medical appointment?”